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2010 
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Initial Response to Chemical, Biological, 
Radiological, Nuclear and 
High-Yield Explosive Incidents 



DEFENSE THREAT REDUCTION AGENCY 

AND THE 

USSTRATCOM CENTER FOR COMBATING WMD 
















PURPOSE STATEMENT 


The following are suggested immediate actions (up to 8 hours) 
taken by an Installation Commander in the event of a chemical, 
biological, radiological, nuclear and/or high-yield explosive 
(CBRNE) terrorist/hostile incident on a Department of Defense 
(DoD) installation in the Continental United States (CONUS). 
For the purposes of standardization and consistency, it is general 
guidance for all Services, and is not meant to supersede any 
individual Service documents/guidance. It is understood that many 
installations already have specific CBRNE response/antiterrorism 
plans. This book is not meant to usurp these plans, but is instead 
general guidance for those installations that do not yet have plans. 
Other DoD and national guidance CBRNE response documents 
should be considered firstly (please see reference list). This 
handbook outlines general actions, specifying procedures to be 
carried out by the Installation Commander and other response 
personnel in the case of each individual CBRNE event. 

DISCLAIMER 

The information in this handbook should be used as basic 
guidance. Nothing in this instruction should be interpreted to 
subsume, replace, detract from, or conflict with, authorities 
and responsibilities of the Installation Commander, DoD, and/ 
or Federal, State and local leadership specified by law or DoD 
guidance. At the scene of any CBRNE incident, circumstances 
vary and are unpredictable. Incidents may require only the most 
rudimentary application of the suggestions made in this document, 
but may also require extremely complex intervention procedures 
that are beyond the scope of this document. 


For assistance or additional information on this handbook 

please contact: 

The Defense Threat Reduction Agency, 
Consequence Management Division 
8725 John Jay Kingman Road M/S 6201 
Fort Belvoir, VA 22060 
(703) 767-4379 
CM@DTRA.MIL 






IMMEDIATE ACTIONS FOR ANY INCIDENT 

♦ Gain Situational Awareness 

♦ Critical Mission Operations Protection 

♦ Life-Saving and Mitigation Operations 

♦ Notify Higher Headquarters 

♦ Notify Installation Personnel 

♦ Notify State and Local Jurisdictions 

♦ Make a Public Announcement, 

(as necessary) 



THINK ABOUT 


♦ Health and Safety 

♦ Security 

♦ Infrastructure / Evacuation 

♦ Public Affairs 

♦ Legal / Claims Issues 

♦ Logistics 

♦ Long-Term Impact 


LC Control Number 



























DoD Management of a Terrorist Incident 



2 



















































































RESPONSE BASICS 

DEFINITION OF A CBRNE INCIDENT 

(From Department of Defense Instruction 2000.18, Enclosure 2): 

The deliberate or inadvertant release of chemical, biological, 
radiological, nuclear or high-yield explosive (CBRNE) devices 
with potential to cause significant numbers of casualties and 

high levels of destruction. 


INSTALLATION COMMANDER’S BASIC RESPONSIBILITIES 

DoD Installation Commanders have responsibility and 
authority for INITIAL RESPONSE, INITIAL CONTAINMENT, and 
NEUTRALIZATION of terrorist/hostile incidents occuring within 

their installation. 


AUTHORITY AND JURISDICTION IN TERRORIST INCIDENT RESPONSES 
Incident Location 

DoD installation or vessel within the United States, its territories and 
possessions 

Initial Response 

DoD military and/or civilian security forces 

Containment of Incident 

Initially DoD military and/or civilian security forces, with transition to 
FBI or civilian law enforcement dependent on jurisdiction 

Incident Resolution 

DoD Security Organizations, Military Emergency Service Team/Special 
Reaction Team or FBI or other appropriate civilian law enforcement 
dependent on jurisdiction 

Incident Investigation (Coordinating Agency) 

FBI and DoD Criminal Investigative Task Force (CITF) for military 
commission crimes 

Prosecution (Coordinating Agency) 

Department of Justice (DOJ) and DoD Office of Military Commissions 
for prosecuting military commission pursuant to President’s Military 
Order of November 13, 2001 


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INSTALLATION COMMANDER’S BASIC RESPONSIBILITIES IN 
THE CASE OF A CBRNE INCIDENT ON THE INSTALLATION 


INSTALLATION COMMANDERS SHOULD IMMEDIATELY : 

1. Activate the installation’s initial response elements and local 
memorandums of understanding/memorandums of agreement 
(MOUs/MOAs). MOUs/MOAs must be utilized in order to make up 
for an installation’s shortfalls and to detect, deter and respond to a 
CBRNE incident. 

2. Initiate the DoD notification process. 

3. Request resources to augment the installation’s response 
capabilities and notify affected local personnel on what protective 
measures to take. 

4. Assume overall initial authority. In accordance with (IAW) DoD 
0-2000.12, DoD Installation Commanders have responsibility 
and authority for initial response, containment and resolution of 
criminal incidents occurring within their installation. The FBI has 
coordinating agency responsibilities for investigation and prosecution 
of alleged violations of U.S. Code or investigating any incidents 

that an Installation Commander declares to be terrorist in nature 
that occur on DoD installations or within DoD facilities. Also, if 
needed, Commanders may ask the FBI for assistance if the FBI has 
superior tactical assets available, such as regional Special Weapons 
and Tactics (SWAT) teams or Hostage Response Teams (HRT). 

The Installation Commander, however, will at all times maintain 
command and control of the installation’s military assets and 
resources. 

According to DoD reference (see page 53 for a complete listing), 
the National Response Framework (NRF) and the Department of 
Homeland Security (DHS) National Incident Management System 
(NIMS), the initial responders to a CBRNE incident should immediately 
identify and report the nature of the situation, isolate the incident, 
and contain the situation. The Installation Commander (or the State/ 
county health department in the case of a localized biological attack) 
must oversee these actions and activate the installation’s Emergency 
Operations Center (EOC). Additionally, the Commander should notify 
specialized response forces, and immediately report the incident to 
the appropriate superior military command EOC, military investigative 
agency, FBI and/or civilian authorities. IAW the NIMS Incident 
Command System (ICS), Installation Commanders should send liaisons 
to the military EOC and State/local EOC (or Joint Field Office (JFO)) and 
FBI Joint Operations Center (JOC), as applicable) to maintain event 
cognizance and request support as required. 





INSTALLATION COMMANDER’S BASIC RESPONSIBILITIES IN 
THE CASE OF A CBRNE INCIDENT ON THE INSTALLATION 


THE FOLLOWING MUST BE ADDRESSED AT THE INSTALLATION-LEVEL : 

♦ Preserving and saving lives 

♦ Preventing human suffering and preserving health and safety 

♦ Securing and eliminating the hazard 

♦ Mitigating the incident 

♦ Protecting critical assets and infrastructure and preventing further 
damage to the installation and maintaining public confidence in 
the installation’s ability to respond to a terrorist/hostile incident 

♦ Incident reporting to higher headquarters 

♦ Enforcing security measures to protect persons and property 

♦ Notification and employment of select first and emergency 
responders 

♦ Consider transfer of critical operations to secondary location(s), 
where applicable 

♦ Impact of uncontrolled movement of contaminated casualties 
(“Self-Referrals”) 

♦ Hazardous material (HAZMAT) response capabilities 

♦ Mass warning of family members, U.S. personnel supporting U.S. 
military operations and allied/coalition personnel 

♦ Notification of emergency-essential military, DoD civilians, 
contractors and off-installation medical resources 

♦ Casualty flow control at military treatment facilities/clinics 

♦ Activation of the EOC 

♦ Evacuation/shelter/shelter-in-place management 

♦ Follow-on incident reporting to higher headquarters 

♦ Establishment of staging areas 

♦ Coordination with local responders 

♦ Casualty tracking 

♦ Plume modeling 

♦ Establishment of mass care capability 

♦ Agent confirmatory testing 


(Concept for list originally from CNI 3440.17(see p.53); additions have been 
made for further response assistance by an Installation Commander) 


5 





WHAT TO ASK DURING THE RESPONSE 


♦ What was detected? What are the symptoms? Was it a chemical, 
biological, radiological, nuclear or high-yield explosive incident? 

♦ Where was the explosion/release? Are there any casualties? 

♦ Did the explosion/release contain more than one CBRNE 
component, and are first responders checking for secondary 
devices? 

♦ Who is the designated incident commander? 

♦ Are there reports of other incidents, locally, nationally, or globally? 

♦ What critical mission operations/facilities are affected? 

♦ What critical operations/facilities can be preserved/relocated? 

♦ Will the incident directly affect the surrounding community or 
multiple jurisdictions? 

♦ If a downwind hazard exists, will it be affected due to weather? How 
will weather patterns affect response capabilities? 

(weather = wind air/speed/direction, rain/run-off, temperatures) 

♦ Do any mutual aid agreements or MOU/MOAs exist? 

♦ What local, State and Federal assistance is available and what 
would be their estimated time of arrival (ETA)? 

♦ What equipment and protective clothing and measures will be 
required? 

♦ What is the status of the work of the first responders? 

♦ Is decontamination a concern? What medical treatment facilities 
are available for casualties? 

♦ What is the status of the installation's mission critical facilities and 
critical support capabilities? 


SUGGESTED INTERMEDIATE PERSONNEL PROTECTIVE MEASURES 

♦ Compartmentalize installation to preserve critical operations 

♦ Be aware of secondary device threats during response efforts in 
rescue area 

♦ Move upwind of the suspected area 

♦ Cover all exposed skin surfaces and protect respiratory systems as 
much as possible 

♦ Evacuate/shelter-in-place, minimizing passage through 
contaminated area 


6 







♦ Confusion, casualties, and blocked road networks may interfere 
with the response efforts and cause a potential for fear amongst 
the local populace. 

♦ Infrastructure damage to include water source and inability to 
account for all personnel due to unknown destruction of buildings/ 
roadways. 

♦ The FBI is the lead jurisdictional authority for investigation and 
prosecution in the case of a terrorist event. Evidence must be 
preserved as much as possible. 

♦ DHS may assume the role of the overall incident manager/ 
coordinator of consequence management operations if the event 
is determined to require a more systematic Federal response 
coordinated through the National Response Framework procedures. 

♦ Press coverage will begin immediately and should be handled by 
the incident Joint Information Center (J 1C). 

♦ If a WMD-Civil Support Team is available, it may be notified through 
the State for additional response support and expertise. 

♦ There may be damage to communications and electronics systems. 


7 








































WMD CONSEQUENCE MANAGEMENT TASKS 


r 


ASSESS 


THREAT 


READINESS 


I 


PLANS AND 
TACTICS, 
TECHNIQUES, 
AND 

PROCEDURES 


DETECTION 
AND ANALYSIS 


SURVEILLANCE 


COORDINATE 

OPERATIONS 


EXERCISES 

WARNING 

AND 

REPORTING 




CONDUCT 

LOGISTICS 


HEALTH 

SERVICE 

SUPPORT 


COMMAND, 
CONTROL, AND 
SYNCHRONIZA¬ 
TION 


ZEZ 



SECURITY AND 
CONTROL 


FORENSICS 

SAMPLE 
COLLECTION 
AND PACKAGING? 


PUBLIC AND 
CIVIL AFFAIRS 
ACTIVITIES 


L 



DE¬ 

CONTAMINATE 


TRANSPORT 
CASUALTIES, 
REMAINS, AND 
SAMPLES | 


PERSONNEL 
AND MATERIAL 
DEPLOYMENT 


FACILITIES AND 
MATERIAL 
MAINTENANCE 


SUPPORT TO 
WEAPONS OF 
MASS 

DESTRUCTION 

DISASTER 

ASSISTANCE 

OPERATIONS 


MITIGATION 


EMERGENCY 

DECONTAMINA¬ 

TION 


RESTORATIVE 

OPERATIONS 


(Figure from Joint Pub 3-40, Figure IV-1) 

This chart from JP 3-40 provides a basic outline of the most common 
DoD tasks and functions that must be addressed during DoD WMD CM 
operations. These tasks and functions are applicable to deliberate, adaptive 
and crisis action planning. Planning for specific tasks and functions required 
for a particular CM mission will be dependent upon the nature of the WMD 
material, meteorological conditions, anticipated impacted population/area 
and desired end states. More detailed information on these tasks and 
functions and operational contexts can be found in Joint Publication 3-41 
(Consequence Management). 


Domestic DoD CM operations where an Installation Commander provides 
support to, or requires support from, adjoining jurisdictions will be conducted 
within the context of Defense Support to Civil Authorities (DSCA). The 
3025-series of DoD Directives, Instructions and Manuals define DoD DSCA 
policy, procedures, and processes consistent with the National Response 
Framework (NRF) and the National Incident Management System (NIMS). The 
NRF defines Federal agency responsibilities and response processes from an 
all-hazards approach, which includes the response to WMD incidents. The NIMS 
provides a common structure for command and control of response activities, 
as well as common concepts, principles, and terminology. Pages 9 and 10 of 
this handbook provide a more detailed overview of the NRF and NIMS. 


8 






























































































































THE NATIONAL RESPONSE FRAMEWORK (NRF) AND THE 
NATIONAL INCIDENT MANAGEMENT SYSTEM (NIMS) 

DoD response to a domestic WMD incident will be conducted consistent 
with the NRF. The following are brief excerpts from the NRF which, 
along with DoD 3025-series publications, should be consulted for 
further reference. 

The NRF and the NIMS integrate the capabilities and resources 
of various governmental jurisdictions, incident management and 
emergency response disciplines, nongovernmental organizations, 
and the private sector into a cohesive, coordinated, and seamless 
national framework for domestic incident management. The NRF, 
using the NIMS, is an all-hazards plan that provides the structure and 
mechanisms for national level policy and operational coordination for 
domestic incident management. Consistent with the model provided in 
the NIMS, the NRF can be partially or fully implemented in the context 
of a threat, anticipation of a significant event, or the response to a 
significant event. 

The NRF, using the NIMS, establishes mechanisms to maximize 
prevention, preparedness, response, and recovery integration and 
improves coordination and integration of Federal, State, local, tribal, 
regional, private-sector, and nongovernmental organization partners. 
The NRF and the NIMS have also been established to efficiently utilize 
resources, improve incident management communications, increase 
situational awareness and facilitate emergency mutual aid and Federal 
emergency support across State, local, and tribal jurisdictions and 
between the public and private sectors. 

The NIMS is a system mandated by HSPD-5 that provides a consistent, 
nationwide approach for Federal, State, local, and tribal governments; 
the private sector; and NGOs to work effectively and efficiently together 
to prepare for, respond to, and recover from domestic incidents, 
regardless of cause, size, or complexity. To provide for interoperability 
and compatibility among Federal, State, local, and tribal capabilities, 
the NIMS includes a core set of concepts, principles, and terminology. 
The incident command system (ICS) forms the basic structure for 
incident management at all levels. An example chart of the basic ICS 
structure, with an additional chart of the Operations section for a multi- 
jurisdictional incident, are provided below. 


9 





The ICS employs a concept of “Unified Command” for complex incident 
management operations where multiple jurisdictions or agencies have 
authority or for incidents at multiple locations. Concepts of “command” 
and “unity of command” have distinct legal and cultural meanings for 
military forces and operations. For military forces, command runs from 
the President to the Secretary of Defense (SECDEF) to the Commander of 
the combatant command to the commander of the forces. The “Unified 
Command” concept utilized by civil authorities is distinct from the military 
chain of command. 

THE DEPARTMENT OF DEFENSE AND THE NRF/NIMS 

The DoD has significant resources that may be available to support the 
Federal response when directed by appropriate national authorities. 

The SECDEF shall provide and authorizes DSCA for domestic incidents 
as directed by the President or when consistent with military readiness 
operations and appropriate under the circumstances and the law. 
Accordingly, the DoD is considered a cooperating agency to the majority of 
the NRF Incident Annexes and a support agency to all Emergency Support 
Functions (ESFs) (except when the USA Army Corps of Engineers is a 


in 















































































primary agency for ESF #3, Public Works and Engineering). For additional 
information on DSCA, refer to the NRF Base Plan and DoD 3025-series 
publications. 

Nothing in the NRF impairs or otherwise affects the authority of the 
SECDEF over the DoD, including the chain of command for military 
forces from the President as Commander-in-Chief, to the SECDEF, to 
the commander of military forces, or any other military command and 
control procedures. The SECDEF shall retain command of military forces 
conducting DSCA operations. 

The Defense Coordinating Officer 

If appointed by DoD, the DCO serves as DoD’s single point of contact 
at the Joint Field Office (JFO) (the temporary Federal organization 
established locally to coordinate operational Federal assistance activities 
to the affected jurisdiction(s)). With few exceptions, requests for DSCA 
originating at the JFO are coordinated with and processed through 
the DCO consistent with DoD Instruction 3025. The DCO may have a 
Defense Coordinating Element (DCE) consisting of a staff and military 
liaison officers in order to facilitate coordination and support to activated 
ESFs. Specific responsibilities of the DCO (subject to modification based 
on the situation) include processing requirements for military support, 
forwarding mission assignments to the appropriate military organizations 
through DoD-designated channels, and assigning military liaisons such 
as Emergency Preparedness Liaison Officers (EPLOs), as appropriate, to 
activated ESFs. 

Immediate Response Authority 

Imminently serious conditions resulting from any civil emergency may 
require immediate action to save lives, prevent human suffering, and/or 
mitigate property damage. When such conditions exist and time does not 
permit approval from higher headquarters, local military commanders and 
responsible officials from DoD components and agencies are authorized 
by DoD directive and pre-approval by the SECDEF, subject to any 
supplemental direction that may be provided by their DoD component, to 
take necessary action to respond to requests of civil authorities consistent 
with the Posse Comitatus Act (18 U.S.C. § 1385). All such necessary 
action is referred to as “Immediate Response” and must be reported 
through the chain-of-command to the NMCC by the most expeditious means. 


11 


Command Structures I Coordination Structures 


NIMS FRAMEWORK AND STRUCTURE FOR NRP COORDINATION DURING A TERRORIST INCIDENT 


NIMS Framework 

Multiagency Coordination Entity 

□ Strategic coordination 

□ Prioritization between incidents and 
associated resource allocadon 

□ Focal point for issue resoludon 


EOCs/Multiagency 
Coordination Centers 

□ Support and coordinadon 

□ Idenutying resource shortages 
and issues 

□ Gathering and providing 
informadon 

Implementing mulitagency 
coordinadon endty decisions 


Field Level Regional Level National Level 



JFO/PFO 


FCO 

SCO 

DCO 

SAC 


□ 


Local Emergency 
Ops Center 


Incident Command 

□ Direct on-scene 

emergency management 

(Area Command opdon 
not depicted) 


Incident 

Command Post 



State Emergency 
Ops Center 


Interagency 

Incident 

Management 

Group 


* Strategic 
Information & 
Operations 
Center 


Joint Field 
Office 


Regional 

Response 

Coordination 

Center 



Homeland 

Security 

Operations 

Center 


* At the field level, the FBI Joint Operations Center coordinates all criminal 
investigation and law enforcement-related activities. When the JFO is 
established, the JOC becomes a component of the JFO. At the 
headquarters level, the FBI Strategic Information and Operations Center 
coordinates criminal investigation and law enforcement-related activities 
and works in coordination with the HSOC and IIMG. The SIOC functions as 
both a mulitagency coordination center and multiagency coordination entity 
as defined in the NIMS. 


JFO = Joint Field Office 

PFO = Principal Federal Official 

FCO = Federal Coordinating Officer 


SCO = State Coordinating Officer 
DCO = Defense Coordinating Officer 
SAC = Special Agent in Charge (FBI) 



















































































CONTACT NUMBERS 


For a complete listing of CBRNE-specific assets/resources by 
installation, please see the DTRA CBRNE Database and/or the Nuclear 
Accident Response Capabilities Listing (NARCL). 


AGENCY 

PHONE # 

LOCATION 

INSTALLATION NUMBE 

RS 

Installation Command Post 



On-Post Fire Department 



On-Post Emergency Dispatch (911 Center) 



Security Forces 



Installation Hospital Emergency Room 



Civil Engineers 



Chaplain 



Commander’s Hotline 



Public Affairs Officer (PAO) 



Explosive Ordnance Disposal (EOD) 

(If Available - If Not, Contact Off-Installation Source) 



Emergency Operations Center (EOC) 



Public Works 



Mortuary Affairs 



Info. Technology/Communications Center 



OFF-INSTALLATION LOCATION-SPECIFIC RESPONSE ASSISTANCE 

Higher Headquarters 



State EOC 



FBI - Local Field Office 



Local Fire Department Per MOU/MOA 



Local Medical Facilities (Ambulance) 



Civilian Bomb Squad Per MOU/MOA 



Regional Federal Radiological Monitoring 
And Assessment Center (FRMAC) Office 



24 Hour Local EOC 



County Help Line Of State/County EOC 



U.S. Department Of Agriculture (USDA) 
(Local Flegional Office) 



U.S. Department Of Health And Human 
Services (HHS) (Local Regional Office) 




13 





































AGENCY 

PHONE # 

LOCATION 

INSTALLATION NUMBERS 

NMCC 

703-693-8196 

703-693-3441 

703-697-6340 

PENTAGON, 
WASHINGTON, DC 

DHS National Operations Center 
(NOC) 

(202) 282-8000 

1-800-462-9029 

WASHINGTON, DC 

National Response Center 

1-800-424-8802 

WASHINGTON, DC 

AFRRI 

(301) 295-0316 

BETHESDA, MD 

IMAAC (NARAC) - Emergency Only 

(925) 424-6465 

WASHINGTON, DC 

DOE/NNSA Operational Emergency 
and Incident Reporting 

(202) 586-8100 

WASHINGTON, DC 

NARAC 

(925) 422-7627 

LIVERMORE, CA 

CDC - Emergency Response Hotline 

(770) 488-7100 

ATLANTA, GA 

CDC Coordinating Office of Terrorism 
Preparedness and Emergency 

Response 

(404) 639-7405 

ATLANTA, GA 

CBIRF - Operations Officer 

(301) 744-2027 

INDIANHEAD, MD 

USAF Hammer Ace 

dsn: 574-5411 

commercial: 

(757) 764-5411 

SCOn AFB, IL 

AFRAT 

dsn: 240-5562 

FRONT OFFICE: 

(210) 536-3486 

SAN ANTONIO, TX 

USAMRIID 

1-888-872-7443 

FT DETRICK, MD 

USAMRICD 

dsn: 584-3277 
(410) 436-3277 

ABERDEEN 

PROVING 

GROUND, MD 

CHEMTREC 

1-800-262-8200 

ARLINGTON, VA 

USDA Operations Center 

(202) 720-5711 
1-877-677-2369 

WASHINGTON, DC 

DTRA Operations Center 

877-240-1187 
dsn: 427-2003 

commercial: 

(703) 767-2003 

ALEXANDRIA, VA 


























CHEM/BIO/RAD DECONTAMINATION 

IHIHH decontamination PRINCIPLES 

♦ For an effective response to a CBRNE incident, an installation must 
have, or have direct access to, trained personnel and specialized 
equipment with HAZMAT capabilities 

♦ Decontaminate: 

■ As soon as possible 

■ Only what is necessary 

■ As close to contaminated area as possible, upwind 

■ With mission priority and health essentials in mind 

♦ Wash exposed areas with soap and water for most immediate 
decontamination effects 

♦ Identify readily-available water sources 


LEVELS OF PERSONAL PROTECTIVE EQUIPMENT (PPE) 

From the Office of Occupational Safety and Health, U.S. Department of Labor and the Environmental 

Protection Agency standards and guidance 

Level A 

To be selected when the greatest level of skin, respiratory, and eye 
protection is required. These fully encapsulating suits afford protection 
against petroleum products and halogenated hydrocarbons, as well as 
against nerve and blister agents. Self-contained breathing apparatuses 
(SCBAs), totally-encapsulating chemical-protective suits, coveralls, 
safety boots/shoes, safety glasses and/or chemical splash goggles are 
recommended. 

Level B 

To be selected when the highest level of respiratory protection is necessary 
but a lesser level of skin protection is needed. Liquid splash-protective 
suits, pressure-demand, full face-piece SCBAs, inner chemical-resistant 
gloves and safety boots, and hard hats are recommended. 

Level C 

To be selected when the concentration(s) and type(s) of airborne 
substance(s) are known and the criteria for using air purifying respirators 
are met. Support function protective garments, full face-piece, air-purifying, 
canister-equipped respirators, chemical resistant gloves and safety boots, 
and hard hats are recommended. 

Level D 

A work uniform may be selected affording minimal protection: used for 
nuisance contamination only. Coveralls, safety boots/shoes, safety glasses 
or chemical splash goggles are recommended. Use Level D protection 
when no danger of chemical exposure exists. Current recommendations for 
PPE to be used in situations of radiation contamination suggest only Level 

D type protection plus a dust filter for respiratory protection. 


15 










SAMPLE OF A CASUALTY DECONTAMINATION-CORRIDOR LAYOUT* 



please see FM 3-11.21, Appendix C 

CONSIDERATIONS WHEN DEALING WITH MASS DECONTAMINATION 

♦ Isolation of contaminated victims within certain areas, or medical 
facilities, if available. 

♦ Quarantines to restrict movement of personnel (and animals) in 
specific areas of the installation. 

♦ Notification of affected public off-installation. 

♦ Proper PPE at all times according to installation/DoD standards 
and requirements. 

♦ Proper handling procedures for deceased collaborated with 
Mortuary Affairs and the State Medical Examiners Office. 
























































































CHEM/BIO/RAD DECONTAMINATION 

IMPORTANT ACTIONS 


♦ Provide concise information on the threat, recommendations on 
what should be done to combat it, and instructions on handling 
victims to all hospitals, clinics, nursing homes, home health care 
agencies, individual physicians, pharmacies, school nursing staffs, 
and other medical providers 

♦ Initiate MOUs/MOAs for civilian medical assistance as the majority 
of installations have limited medical care expertise; the local health 
department or state public health region field office will typically 
take the lead in coordinating the local medical response when 
installation assets are overwhelmed 

♦ In most instances, respirators, M40/MCU-2P masks, or adequate 
levels of personal protective equipment (PPE) will be required 

♦ Removal of outer clothing & rapid washing of exposed skin generally 
removes 90% of contamination 

♦ Use caution when removing clothing from burned patients to 
prevent aggravation & further contamination of wounds 

♦ Run-off may be contaminated, as will any used materials (wound 
dressings, protective gear, etc.), and should be collected in a 
protected location for disposal 

♦ Take care moving injured personnel to avoid re-contamination of 
clean individuals 


SAMPLE OF A PERSONNEL DECONTAMINATION-STATION LAYOUT 



17 













































CHEMICAL DECONTAMINATION 



♦ Respirator, M40/MCU-2P masks, or adequate levels of PPE are 
required 

♦ A clean treatment area should be established immediately 

♦ Mild soap and hot water can be used to remove most, if not all, of 
the agent/gross contamination 

♦ A diluted bleach solution (1 part bleach, 200 parts water) may be 
used for more complete skin decontamination 

♦ Antidotes, when available, should be administered in the 
contaminated areas, if possible (i.e. Nerve Agent Antidote Kits 
(NAAK)) 

♦ Ensure medical responders, transport units, and receiving medical 
facilities are properly protected against secondary contamination 

♦ Use Level A PPE if substance is unknown and move up equipment 
level as required by agent effects 

♦ Know an immediately available water source 

♦ Run-off needs to be contained 

♦ Review procedures for storage and disposal of contaminated 
materials 

♦ Consider replacement of clothes 


BIOLOGICAL DECONTAMINATION 

i . . .. i ISSUES 

♦ Respirator, M40/MCU-2P masks, or adequate levels of PPE 
are required 

♦ Inhalation is the most likely and largest area of concern for 
biological agents 

♦ Scrubbing exposed area with mild soap and water is often 
sufficient to avert contact spread of agent - note that runoff will be 
contaminated 

♦ Replacement of contaminated clothing with clean clothing 

♦ Undiluted household bleach may assist in clothing and equipment 
decontamination (with 30 minutes of contact time and a solution 
of 1 part bleach, 100 parts water) and skin decontamination 

(1 part bleach, 200 parts water) 





















RADIOLOGICAL DECONTAMINATION 


l- .... 




ISSUES 


.4 


♦ Respirator, M40/MCU-2P masks, or adequate levels of PPE are 
required 

♦ Radioactive contamination continues to irradiate nearby living 
things 

♦ Contaminated patients do not present an immediate irradiation 
hazard to medical personnel with normal protection; following 
decontamination, they are no longer hazardous 

♦ Decontamination should occur before arrival at installation medical 
facilities, but definitive medical health care should not be withheld 
for decontamination purposes 

♦ Most external radioactive contamination can be eliminated by the 
removal of clothing 

♦ If the casualty has surface contamination and no physical injuries, 
washing with soap and water provides effective decontamination 

♦ If a contaminated casualty has substantial physical injuries, the 
casualty should be stabilized before decontamination is performed 

♦ Be sure skin is washed thoroughly, but GENTLY - abrasions on the 
skin will lead to internal contamination 

♦ A living patient cannot be so radiologically contaminated as to 
present an acute hazard to medical personnel; life/limb-saving 
medical attention should never be delayed because of the 
presence of radioactive material or contamination 


19 







RADIOLOGICAL CASUALTY DECONTAMINATION 



The following diagram from AFRRI’s Medical Management of 
Radiological Casualties Handbook shows a setup for casualty reception 
in a contaminated environment. The actual setup of this area may vary 
depending on assets and circumstances. 











































































CHEMICAL INCIDENT 

INDICATIONS OF A CHEMICAL INCIDENT 


♦ May not be easily detectable by senses 

♦ Chemical cloud may exist; unusual number of dead or dying 
animals or insects in the area 

♦ Unexplained odors (smell of bitter almonds, peach pits, newly 
mown hay, or green grass); some agents may be odorless 

♦ Unusual liquid or unauthorized spraying in the area; agents may be 
released as tiny droplets, similar to the release of an insecticide 

♦ Often large numbers of victims display a sudden onset of symptoms 
of nausea, difficulty breathing, convulsions, disorientation, or 
patterns of illness inconsistent with natural disease 

♦ Low-lying clouds or fog unrelated to weather; clouds of dust; or 
suspended, possibly colored, particles 

♦ The effect of a chemical agent depends on its concentration and 
type; smaller doses of the agent may or may not kill 

♦ Some chemical agents are heavier than air, consequently when 
sheltering-in-place, remain out of low-lying areas, such as ditches 
or ravines 



EXAMPLES OF CHEMICAL AGENTS 

type/ 

AGENT 

EXAMPLE 

MECHANISM OF 
ATTACK 

TIME OF ONSET 
OF SYMPTOMS 

SYMPTOMS 

Blister 

Mustard (H) 

Skin and tissue 
destruction on 
contact 

Hours 

Redness of skin, skin 
blistering, eye irritation, 
blindness, and lung disease 

Nerve 

Sarin (GB) and 
VX 

Nervous system 
disruption on 
inhalation or 
contact 

Seconds to 
minutes 

Dim vision, muscular 
twitching, salivation, difficulty 
breathing, nausea, and 
convulsions 

Blood 

Cyanogen 
chloride (CK) 
Hydrogen 
cyanide (AC) 

Blocking of blood 
and oxygen on 
inhalation 

Seconds to 
minutes 

Dizziness, nausea, vomiting, 
headaches, and convulsions 

Choking 

Phosgene (CG) 
Chlorine 

Luna damage on 
inhalation 

Min. for initial 
symptoms, 
several hrs. 
for later 
symptoms 

Eye and airway irritation, 
tightness in the chest, 
shortness of breath, and 
fluid in the lungs 


IN THE EVENT OF A CHEMICAL INCIDENT CONTACT 
THE NATIONAL MILITARY COMMAND CENTER (NMCC) 

(703) 692-2387 

(24 HOURS/7 DAYS A WEEK) 


21 










































INCIDENT (I) TO 1+15 MIN - RESPONSE CHECKLIST 

♦ Gain situational awareness 

♦ Initiate concept of operations, if it exists 

♦ Continue the mission and critical operations 

♦ Limit further damage to lives and property (contain the 
situation) 

♦ Notify the NMCC via Operational Report (0PREP)-3 incident report 
of terrorist/hostile chemical incident 

♦ Confirm direct notification of Higher Headquarters, Fire, Emergency 
Medical Services (EMS), Security Forces, EOD, HAZMAT and 
Chemical Response Team, if available 

♦ Adjust Force Protection (FPCON) level 

♦ Activate Installation Command Post (ICP) or EOC 

♦ Appoint an incident commander (usually senior Fire official at 
incident) 

♦ Notify State and local authorities as defined in MOUs/MOAs 

♦ Initiate mass notification via EOC (installation emergency alert 
system) 

♦ Determine protective measures 

♦ Confirm first responders have made initial assessment; 
established an on-scene command post, cordon, entry/exit points 
and staging area; are mitigating the situation; and are performing 
life-saving operations and initial casualty decontamination 

♦ Confirm first responders have established hazardous/ 
contamination control zones and are utilizing personal protection 
equipment and decontamination supplies and antidotes, if 
available 

♦ Ensure first responders have checked for secondary devices 

♦ Identify possible further health/medical needs and available 
resources/equipment 

♦ Contact key health personnel (CDC, local hospitals, etc.) 

♦ Identify affected individuals, if necessary, implement 
contamination avoidance measures (i.e. quarantine) and confirm 
establishment of casualty holding area 

♦ Ensure preservation of evidence on-scene (crime scene) 












1+15 MIN TO 1+1 HR - RESPONSE CHECKLIST 

♦ Ensure Security Forces are implementing protection procedures of 
personnel and installation 

♦ Assess infrastructure on-installation (communications, damage 
assessment, water/sewage/electricity, control of food, housing); 
issue notices, if necessary 

♦ Activate JIC for incident announcements on and off-installation; 
monitor notification of local/civilian public with emergency alert 
system via radio/TV, mobile public address systems, and sirens 
via JIC; JIC will also process media requests for information and 
announcements 

♦ Confirm installation mass notification and notification of affected 
local population (include directions for personal protection in public 
announcement) 

♦ Activate installation shelter-in-place or evacuation plans via EOC 
and Security Forces 

♦ Identify available transportation; direct coordination of alternate 
means/routes 

♦ Conduct follow-on reports to higher headquarters via situation 
report (SITREP) 

♦ Readjust FPCON level, if necessary 

♦ Work with Higher Headquarters to coordinate arrival of DoD/ 
Federal response teams 

♦ Ensure local off-installation assistance/mutual aid has access to 
installation and is arriving 

♦ Begin/obtain personnel accounting information 

♦ Confirm first responders are attempting identification of agent and 
scope of damage 

♦ Confirm decontamination efforts; redefine boundaries of hazard/ 
contamination control zones based on new information 

♦ Assist in evacuation/relocation/traffic redirection, if necessary, via 
Security Forces 

♦ Confirm and maintain contact with local and State EOCs, if 
activated 

♦ Determine size/scope and ETA of DoD/Federal assets 

♦ Confirm health and security personnel have cleared and secured 
on-installation hospital entrances and grounds 



CONTINUED... 

23 













1+15 MIN TO 1+1 HR (CONT’D) - RESPONSE CHECKLIST 

♦ Confirm all health centers (on-installation and off, if needed) 
are able to provide sufficient emergency care and that 

only life threatening injuries are receiving treatment before 
decontamination (public should be directed to seek medical 
attention only when needed) 

♦ Seek medical advisors for possible preventative measures or 
limiting the effects of the chemical agent 

♦ Assess status of local public transportation, private/military 
transportation assets 

1+1 HR TO 1+4 HRS - RESPONSE CHECKLIST 


♦ Continue notification of installation/local/civilian public via JIC 

♦ Confirm entry/exit control of arriving mutual aid at staging area 

♦ Coordinate with and brief arriving local, State, Federal and DoD 
agencies and assets 

♦ Complete personnel accountability 

♦ Determine how to transport personnel on/off/within the 
installation, if necessary; if evacuating, Security Forces will direct 
this process 

♦ Confirm and monitor continuation of response and recovery 
operations and decontamination station upwind of the hot zone 

♦ Confirm recharge of installation capabilities, if necessary 

♦ Monitor decontamination efforts; ensure first entry team has been 
decontaminated 

♦ Appropriate office (most installations, Legal Affairs) will make 
family notifications 

♦ Confirm presumptive identification of agent type 

♦ Continue preservation of evidence measures 

♦ Confirm non-ambulatory casualties are removed during casualty 
extraction 

♦ DoD will provide personnel, chemical weapon response resources 
and airborne sampling on request - EOC must coordinate request 

♦ Continue personnel accounting of contaminated casualties at 
hospitals; coordinate with Mortuary Affairs for dead and continue 
advisory shelter-in-place/evacuation options 

♦ Ensure provision of basic needs begins, if necessary 























♦ Monitor public announcements as new information warrants 

♦ Continue monitoring decontamination actions 

♦ Continue monitoring evacuation status, if necessary 

♦ Continue monitoring response and recovery operations 

♦ State and local health departments and HHS will ensure availability 
of medical care/other human services, crisis counseling, chemical 
incident advice, etc. 


♦ DHS will work to provide the installation with consequence 
management and mitigation support IAW the NRF, and may 
activate the NRF Terrorism Annex 


♦ If directed by appropriate national authorities IAW the NRF, DHS will 
become the lead authority; FBI will maintain investigative authority 
and installation will support efforts 

♦ If DHS and/or the FBI does not assume lead IAW the NRF, the 
installation will remain the lead authority for all consequence 
management and crisis management coordination, efforts and 
actions 

♦ USDA may be contacted for food and agricultural contamination 
issues 


♦ Continue monitoring installation’s infrastructure and provision 
capabilities 



(From JP 3-11) 


The hazards from a chemical strike may last for less than an hour or 
for several weeks. The effects on personnel may be immediate. For 
units forced into high levels of protection, missions will take longer to 
perform. A summary of chemical weapon effects for persistent and 
nonpersistent agents is shown on the next page. 


25 























CHEMICAL WEAPONS EFFECTS 

The following types of agents and their effects are based on military 
weaponized chemical agents. Toxic industrial chemicals/materials (such 
as chlorine or cyanide), which may be found near or on an installation, 
must also be considered. Their effects will be similar to those found below. 


CHEMICAL WEAPONS EFFECTS 

CHEMICAL AGENT 

TARGET OF CHOICE 

TARGET EFFECT 

NONPERSISTENT NERVE 

PERSONNEL 

IMMEDIATE AND LETHAL 

PERSISTENT NERVE 

PERSONNEL, MATERIAL, 
LOGISTICS AND COMMAND 

AND CONTROL FACILITIES 

REDUCED OPERATIONS 

TEMPO OR MISSION 

degradation; lethal or 

CASUALTY-PRODUCING 

PERSISTENT BLISTER 

SAME AS PERSISTENT NERVE 

SAME AS PERSISTENT NERVE 

NONPERSISTENT 

BLOOD AND NON 
PERSISTENT CHOKING 

PERSONNEL 

IMMEDIATE, LETHAL OR 

CASUALTY PRODUCING 


Information taken from Joint Publication 3-11, Figure D-1 


THREAT CHEMICAL AGENTS 

TYPES 

SYMPTOMS 

EFFECTS 

RATE OF 
ACTION 

RELEASE 

FROM 

NERVE 

DIFFICULTY BREATHING. 
SWEATING, DROOLING, 
NAUSEA, VOMITING, 
CONVULSIONS, AND 
DIMMING OF VISION. 
SYMPTOMS USUALLY 
DEVELOP QUICKLY. 

INCAPACITATES AT 

low concentration; 

KILLS IF INHALED OR 
ABSORBED THROUGHT 
THE SKIN OR EYES. 

VERY RAPID BY 

INHALATION OR 
THROUGH THE 
eyes; SLOWER 
THROUGH SKIN. 

AEROSOL, 

VAPOR, OR 

LIQUID. 

BLOOD 

AND 

CHOKING 

DIFFICULTY 

breathing; coma. 

KILLS IF HIGH 
CONCENTRATION 

ARE INHALED. 

RAPID. 

AEROSOL OR 
VAPOR. 

BLISTER 

SYMPTOMS RANGE 

FROM IMMEDIATE TO 
DELAYED, DEPENDING 

ON AGENT. SEARING 

OF EYES AND STINGING 

OF SKIN. POWERFUL 
IRRITATION OF EYES, 

NOSE AND SKIN. 

BLISTERS SKIN 

AND RESPIRATORY 
tract; CAN CAUSE 
TEMPORARY 

BLINDNESS. SOME 

STING AND FORM 

WELTS ON THE SKIN. 

BLISTERS FROM 
MUSTARD MAY 
APPEAR SEVERAL 
HOURS AFTER 
EXPOSURE, 
WHEREAS 

LEWISITE CAUSES 
BLISTERS WITHIN 
MINUTES OF 
EXPOSURE. 

LIQUID OR 
DROPLETS. 


Taken directly from Joint Publication 3-11, Figure D-2 






















BIOLOGICAL INCIDENT 

INDICATIONS OF A BIOLOGICAL INCIDENT 

♦ Primary care physicians, hospitals, pharmacies & EMS 
providers will begin to notice off-season symptoms (similar to a flu 
outbreak to include symptoms like unexplained gastrointestinal 
illnesses and upper respiratory problems); careful to note that 
symptoms may occur during on-season as well 

♦ Potential lag-time between employment and on-set of symptoms 
(except for fast-acting agents, e.g., ricin) 

♦ Most biological agents have incubation period of 1-7 days before 
on-set of symptoms, thus potential for widespread contamination 
through affected personnel is great; detection will occur several 
hours/days/weeks after original dissemination 

♦ Evidence of a disease that is unusual or does not occur naturally in 
a given area or manifestation of multiple disease symptoms in the 
same patients; indicates mixed agents 

♦ Large numbers of military and civilian casualties may be affected 
within a geographic area 

♦ Data suggesting an outbreak from a definitive source 

♦ Large die-off in multiple species of animals 

♦ Absence of a natural cause for the outbreak 

♦ Biological agents can be classified as pathogens or toxins. Human 
pathogens are defined as organisms that cause disease in man. 
Pathogens include bacteria, rickettsia, fungi, and viruses. Naturally 
occurring toxins are non-living byproducts of cellular processes that 
can be lethal or highly incapacitating. Page 32 provides a synopsis 
of several potential biological agents and their ranges of effects 
(JP 3-11). 




IN THE EVENT OF A BIOLOGICAL INCIDENT 

CONTACT 

THE NATIONAL MILITARY COMMAND CENTER (NMCC) 

(703) 692-2387 

(24 HOURS/7 DAYS A WEEK) 


27 







MORE BIOLOGICAL INDICATIONS AND INFORMATION 


METHODS OF DISPERSAL 

1) Airborne via liquid droplets/aerosolized spray - hard to detect 
and is effective in covering large areas with minimal amounts of 
agent and equipment 

2) Blood/body fluids 

3) Food and water source introduction 

4) Infected animal (vector) release 

5) Dry powders (for example, via the postal system) 

IMPORTANT TO NOTE 

♦ May result in high mortality rates and have the potential for major 
public health impact, as well as cause public panic and social 
disruption 

♦ Requires special action for public health preparedness 

♦ Time required before symptoms are observed is dependent on the 
agent used and the dose received 

♦ Most important is to identify an unfolding event early and be able to 
screen personnel rapidly and distribute antidotes effectively 

♦ Best protection is hand-washing, masks and shelter-in-place 

♦ There will be a need for an early decision to quarantine; coordinate 
with local department of health 

♦ On-installation in-patient medical facility will need surge/storage 
isolation facility 

♦ Agent can be identified with 100% accuracy only in a lab; results 
may be available within 24 - 48 hours 

♦ Timely identification and communication of the attack is essential 
in treating and controlling the disease and limiting the effect on 
personnel 

♦ Preventive medicine specialists shall be required to assist 
Commanders with identifying safe food and water sources in 
determining when to use treatment, immunization, and other 
preventative measures 



28 






IMMEDIATE DISCOVERY (OVERT SCENARIO) 

INCIDENT (I) TO I + 1 HOUR - RESPONSE CHECKLIST 

If an unknown biological agent/material is immediately present 

and discovered at the installation, follow the same general 

response activities as a CHEMICAL INCIDENT, with the following 

additional actions: 

♦ Upon possible discovery of any biological agent, notify first 
responders 

♦ If a suspect package is found, leave where discovered and contact 
HAZMAT team, EOD, CDC and/or CBIRF, if available 

♦ Clear the area, close any doors, and take actions to prevent entry 
into the area; shut off ventilation system(s) 

♦ Advise personnel to immediately wash hands with soap and water 
to prevent spread; seek medical expert advice for exposed or 
potentially-exposed personnel 

♦ Inform first responders where washing of hands took place for 
contaminated run-off 

♦ Collaborate in creation of list of personnel that may have had 
contact with package or room where agent/material was found and 
provide to public health authorities and Security Forces 

♦ Notify State and local authorities as defined in MOUs/MOAs 

♦ First responders will monitor for amounts of contamination, FBI 
must be notified if a terrorist event is suspected 

♦ To reduce panic, make a public announcement via EOC or 
activated JIC 

♦ Quarantine affected area/personnel, as needed 

♦ Begin setup of an office/area for incident information/advice 

♦ Ensure preservation of evidence on-scene (crime scene) 

♦ DHS will work to provide the installation with consequence 
management and mitigation support IAW the NRF, and may activate 
the NRF Terrorism Annex. 

♦ If directed by appropriate national authorities IAW the NRF, DHS will 
become the lead authority; FBI will maintain investigative authority 

and installation will support efforts 

♦ If DHS and/or the FBI does not assume lead IAW the NRF, the 
installation will remain the lead authority for all consequence 
management and crisis management coordination, efforts and 

actions 



29 












DELAYED DISCOVERY: 

DAY 1 TO DAY 7 - RESPONSE CHECKLIST 

NO NOTICE. HOSPITALS INDICATE ATYPICAL ACTIVITY: 

♦ Direct installation or request local department of health undertake 
an investigation 

♦ Notify the NMCC via OPREP-3 incident report of possible terrorist/ 
hostile incident (DoD will make recommendations as the situation 
necessitates) 

♦ Notify State and local authorities as defined in the MOUs/MOAs 

♦ The local health department or State Public Health Region 
Field Office, as the entities most familiar with community 
health providers, will typically take the lead in coordinating the 
local medical response, until Federal assets are available or 
requested for support 

♦ Alert Security Forces 

♦ Notify local Emergency management and services organizations of 
situation (Fire, EMS, police) 

♦ Warn medical community/health departments of situation, 
potential effects 

♦ Contact neighboring jurisdictions to determine status (same? 
different?) 

♦ Advise installation/community leaders of best protective measures 

♦ Prepare public statement via EOC or activated JIC 

■ Advise persons to stay in their homes 

■ Advise persons to seek medical attention only if necessary 

♦ Confirm initial determination of illness(es) and cause(s) (agent) 

■ Determine contagiousness 

♦ Make outbreak determination (if necessary) 

♦ DHS will make a determination if Incident of National Significance 
(refer to last three bullets on previous page) 

♦ Coordinate decision to quarantine with local health department 

♦ Facilitate personnel health screening and treatment 

♦ Facilitate antidote issuance and treatment 

♦ Make CDC request (Strategic National Stockpile request) for 
additional medication via installation hospital, if necessary 

♦ Seek medical advisors for possible preventative measures or 
limiting the effects of biological agent 

♦ Put out extensive literature/information on proactive measures for 
the population to prevent transmission of the infection 

♦ Ensure preservation of evidence on-scene (crime scene) 






DELAYED DISCOVERY: 

DAY 7 TO DAY 14 - RESPONSE CHECKLIST 

♦ Facilitate access of medical screeners to affected personnel 

♦ Follow up with installation or local department of health 
undertaking the investigation 

♦ Ensure Security Forces are maintaining public order 

♦ Continue close communication with the medical community about 
hospital status 

♦ Monitor status of neighboring jurisdictions 

♦ Continue public statements as more information becomes 
available 

♦ Direct increased surveillance for identified symptoms 

♦ Determine and confirm case definition and attack rate 

♦ Confirm persons likely infected; request suggested actions from 
expert medical personnel 

♦ Confirm receipt of formal identification of outbreak contaminant 

♦ Update local, State and Federal notifications (CDC, FBI, 

HHS, etc.) 

♦ Hospitals, health care centers will maintain standard precautions/ 
actions and provide installation with updates 

♦ Appropriate office (most installations, Legal Affairs) will make 
family notifications 



DELAYED DISCOVERY: 

DAY 14 TO DAY 21 - RESPONSE CHECKLIST 

♦ Follow up with installation or local department of health 
investigation 

♦ Monitor status of public and protective measures being taken 

♦ Update local, State and Federal notifications (CDC, FBI, HHS, etc.) 

♦ Hospitals, health care centers will maintain standard precautions 
unless severe contagiousness is determined; Federal agencies and 
DoD will provide actions to installation if severe contagiousness is 
determined 

♦ Monitor and confirm reachback capabilities and actions of CDC 
(Strategic National Stockpile), civilian hospital capabilities and 
MOUs/MOAs 



31 











POTENTIAL BIOLOGICAL AGENTS 

DISEASE OR AGENT 

ROUTES OF 
INFECTION 1 

UNTREATED 

MORTALITY 

(%) 

INCUBATION 

PERIOD 

VACCINE 

TREATMENT 

ANTHRAX (BACILLUS 
ANTHRACIS) 

S, D, R 

s: 5-20% 

R: 80-90% 

1-4 DAYS 

YES 

ANTIBIOTICS 

(limited 
EFFECTIVENESS 
AFTER SEVERE 
SYMPTOMS 
develop) 

BOTULINUM 

NEUROTOXINS 

D, R 

60% 

1-4 DAYS 

ind; 

AVAILABLE 
ONLY UNDER 
FDA- 

APPROVED 

PROTOCOL 

IMMEDIATE 

ANTITOXIN 

PLAGUE (YERSINIA 
PESTIS) 

V, R 

bubonic: 50% 
PNEUMONIC 
100% 

2-3 DAYS 

NO 

ANTIBIOTICS 

Q FEVER (COXIELLA 

burnetii) 

V, R 

<1% 

2-10 DAYS 

IND 

ANTIBIOTICS 

RICIN TOXIN 

D, R 

35-39% 

1-3 DAYS 

NO 

SYMPTOMATIC 

STAPHYLOCOCCAL 
ENTEROTOXIN B 

D, R 

< 1% 

4-6 DAYS 

NO 

SYMPTOMATIC 

SMALLPOX 

R 

35-39% 

10-12 DAYS 

AVAILABLE 
ONLY FROM 
CONTROLLED 
US STOCK 

SUPPORTIVE 

TULAREMIA 

D, R, V 

30-60% 

2-10 DAYS 

IND 

ANTIBIOTICS 

VENEZUELAN EQUINE 
ENCEPHALITIS 

R, v 

<1% 

2-6 DAYS 

IND 

SUPPORTIVE 

VIRAL HEMORRHAGIC 
FEVERS (EBOLA, 
MARBURG, LASSA, 

RIFT VALLEY, 

DENGUE, ETC.) 

DC, R, V 

UP TO 90% 

(depends 

ON VIRUS) 

3-21 DAYS 

NO 

SYMPTOMATIC 
(SOME MAY 

RESPOND TO 

ribavirin) 

D - DIGESTIVE SYSTEM DC = DIRECT CONTACT R = RESPIRATORY S = SKIN V = VECTOR 
IND = INVESTIGATIONAL NEW DRUG FDA = FOOD & DRUG ADMINISTRATION 

NOTE! 1 RESPIRATORY WOULD BE THE PRIMARY ROUTE OF ENTRY IN A BIOLOGICAL ATTACK; AND THE 

MOST PROBABLE MODE OF DISSEMINATION WOULD BE RELEASE OF A BIOLOGICAL AGENT THROUGH 
AEROSOL DELIVERY. 


Information taken from Joint Publication 3-11, Figure C-1 






















RADIOLOGICAL INCIDENT 

INDICATIONS OF A RADIOLOGICAL INCIDENT 

* According to AFRRI’s Medical Management 
of Radiological Casualties Handbook: 

♦ Material dispersed can originate from any location using 
radioactive sources (nuclear waste processors, nuclear power 
plants, university research facilities, medical radiotherapy clinics, or 
industrial complexes) 

♦ Exposure may be known/recognized or clandestine through: 

■ Large recognized exposures, such as radiological dispersal 
devices (any device that causes the purposeful dissemination of 
radioactive material across an area without a nuclear detonation; a 
radioactive source is blown up using conventional explosives and is 
scattered across the targeted area as debris) 

■ Small radiation source emitting continuous gamma radiation 
producing group or individual chronic intermittent exposures 
(such as radiological sources from medical treatment devices or 
environmental water or food pollution) 

♦ Exposure may result from one or any combination of the following: 

■ External (such as skin contamination with a radioactive material) 

■ Internal (absorbed, inhaled, or ingested radioactive material) 

♦ Conventional explosion: will cause injury from the physical effects 
of the blast (debris scattered from explosion) in addition to the 
radiation and heavy-metal hazard inherent in many radioactive 
materials 

♦ Psychological effects: severity will depend on the nature of the 
material and method of deployment; number of casualties from blast 
and a more frantic situation will intensify stress among personnel 

Intermittent/Chronic Exposure Symptoms: 

♦ Headache, fatigue, weakness 

♦ Anorexia, nausea, vomiting, diarrhea 

♦ Partial and full thickness skin damage, hair loss, ulceration 

♦ Low white blood cell count, a decrease in blood platelets, skin 
hemorrhaging, opportunistic infections 

Specific Symptoms of Concern, especially with a 2-3 week prior 
history of nausea and vomiting: 

♦ Thermal burn-like skin effects without documented thermal exposure 

♦ Immunological dysfunction with secondary infections 

♦ A tendency to bleed (nose, gums) 

♦ Decreased ability for blood clotting 



IN THE EVENT OF A RADIOLOGICAL INCIDENT 
CONTACT THE NATIONAL MILITARY COMMAND CENTER (NMCC) 
(703) 692-2387 (24 HOURS / 7 DAYS A WEEK) 


33 







IMPORTANT INFORMATION ON RADIOLOGICAL DISPERAL 


According to DoD Concept of Operations for CBRNE Defense 

Supporting US Military Installation and Facility Preparedness: 

♦ Low-level radiological material is available from a large number of 
industrial sources worldwide. 

♦ Terrorists able to gain access to this material could exploit it using 
explosive devices (or devices such as aerial sprayers or hidden 
stationary sources). 

♦ Specific examples of terrorist/hostile radiological hazards include 
iridium, cobalt, cesium, and highly enriched uranium (HEU) as the 
core of a radiological dispersal device. 

♦ Although rarely lethal in the near-term, the deliberate 
dissemination of radioactive matter can cause considerable 
immediate psychological harm. At moderate dosages, exposed 
personnel could also experience delayed effects or might develop 
cancer decades later. 

Treatment Considerations (from AFRRI’s Medical Management of 

Radiological Casualties Handbook): 

♦ If trauma is present, treat 

♦ If external radioactive contaminants are present, decontaminate 

♦ If radioiodine (reactor accident) is present, consider giving 
prophylactic potassium iodide (Lugol’s Solution) within first 24 
hours only (ineffective later) 

Decontamination Considerations (from AFRRI’s Medical Management of 

Radiological Casualties Handbook): 

♦ Exposure without contamination requires no decontamination 
(Radiation Safety Officer (RSO) measurement) 

♦ Exposure with contamination requires Universal Precautions, 
removal of patient clothing, and decontamination with water 

♦ For internal contamination, contact RSO and/or nuclear medicine 
physician 

♦ Treating contaminated patients before decontamination may 
contaminate the facility; plan for decontamination before arrival 

♦ Patient with life-threatening condition: treat, then decontaminate 

♦ Patient with non-life-threatening condition: decontaminate, then 
treat 




INCIDENT (I) TO 15 MIN - RESPONSE CHECKLIST 

4 Gain situational awareness 
4 Initiate concept of operations, if exists 
4 Continue the mission and critical operations 
4 Limit further damage to lives and property (contain the 
situation) 

4 Notify the NMCC via OPREP-3 incident report of terrorist/hostile 
radiological incident (ensure nuclear detonation is not reported) 

4 Confirm direct notification of Higher Headquarters, Fire, EMS, 
Security Forces, EOD, radiological response assets, if available 

4 Adjust FPCON level 
4 Activate ICP/EOC 

4 Appoint an incident commander (usually senior fire official at 
incident) 

4 Notify State and local authorities as defined in the MOUs/MOAs 
4 Initiate mass notification via EOC (installation emergency alert 
system) 

4 Determine protective measures 

4 Confirm first responders have made initial assessment; 

established an on-scene command post, cordon, entry/exit points 
and staging area; mitigated the situation; and are performing 
life-saving operations and initial casualty decontamination 
4 Confirm first responders have established hazardous/ 

contamination control zones and are utilizing personal protection 
equipment and decontamination supplies 
4 Ensure first responders have checked for secondary devices 
4 Identify possible further health/medical needs and available 
resources/equipment 

4 Contact key health personnel (radiological assistance teams/ 
agencies, local hospitals, etc.) 

4 Identify affected individuals, if necessary, implement 

contamination avoidance measures for surrounding incident area 
4 Ensure preservation of evidence on-scene (crime scene) 


35 





1+15 MIN TO 1+1 HR - RESPONSE CHECKLIST 


♦ Ensure Security Forces are implementing protection procedures of 
personnel and installation 

♦ Assess infrastructure on-installation (communications, damage 
assessment, water/sewage/electricity, control of food, housing); 
issue notices, if necessary 

♦ Activate JIC for incident announcements on and off-installation; 
monitor notification of local/civilian public with emergency alert 
system via radio/TV, mobile public address systems, and sirens 
via JIC; JIC will also process media requests for information and 
announcements 

♦ Confirm installation mass notification and notification of local 
affected population (include directions for personal protection in 
public announcements) 

♦ Activate installation shelter-in-place or evacuation plans via EOC 
and Security Forces 

♦ Confirm establishment of cordon for first responders until radiation 
levels have been determined 

♦ Conduct follow-on reports to Higher Headquarters via SITREP 

♦ Readjust FPCON level, if necessary 

♦ Work with higher headquarters to coordinate arrival of Federal/ 
DoD response teams 

♦ Identify available transportation; direct coordination of alternate 
means, routes 

♦ Ensure local off-installation assets (mutual aid) have access to 
installation and are arriving 

♦ Begin/obtain personnel accounting information 

♦ Monitor response and recovery actions; confirm type of radiation 
and dispersal means known 

♦ Confirm decontamination efforts; boundaries of hazardous/ 
contamination control zones redefined based on new information 

♦ Assess Medical Center capabilities to handle contaminated 
casualties 

♦ Assist in evacuation/relocation/traffic redirection preparation if 
necessary, via Security Forces 



CONTINUED... 





1+15 MIN TO 1+1 HR (CONT’D) - RESPONSE CHECKLIST 


♦ Confirm and maintain contact with local and State EOCs, if 
activated 

♦ Determine size/scope and ETA of DoD/Federal assets 

♦ Confirm health and security personnel have cleared and secured 
on-installation hospital entrances and grounds 

♦ Confirm all health centers (on-installation and off, if needed) 
are able to provide sufficient emergency care and that 

only life threatening injuries are receiving treatment before 
decontamination (public should be directed to seek medical 
attention only when needed) 

♦ Assess status of local public transportation, private/military 
transportation assets 

♦ Seek medical advisors for possible preventative measures or 
limiting the effects of radiation 


1+1 HR TO 1+4 HRS - RESPONSE CHECKLIST 


♦ Continue notification of installation/local/civilian public via JIC 

♦ Confirm entry/exit control of arriving mutual aid at staging area 

♦ Coordinate with/brief arriving State, Federal and DoD agencies 

♦ Complete personnel accountability 

♦ Monitor continued response and recovery efforts and 
decontamination efforts 

♦ Determine how to transport people on/off/within the installation, if 
necessary; if evacuating, Security Forces will direct this process 

♦ Installation may request the radiological assistance teams or 
agencies (i.e. the FRMAC) 

♦ Department of Energy (DOE) and DTRA (Hazard Prediction and 
Assessment Capability (HPAC)) (202-586-2830 and 1-877-240- 
1187 respectively) can model plumes; requests should go through 
their EOCs in Washington, D.C. 

♦ Appropriate office (most installations, Legal Affairs) will make 
family notifications 

♦ Confirm presumptive identification of radiation type 

♦ Continue preservation of evidence measures CONTINUED ... 



37 










1+1 HR TO 1+4 HRS (CONT’D) - RESPONSE CHECKLIST 


♦ Confirm non-ambulatory casualties are removed during casualty 
extraction 

♦ Continue personnel accounting of contaminated casualties at 
hospitals; coordinate with Mortuary Affairs for dead and continue 
advisory shelter-in-place/evacuation options 

♦ Ensure provision of basic needs begins, if necessary 



1+4 HRS TO 1+8 HRS - RESPONSE CHECKLIST 



♦ Monitor public announcements as new information warrants 

♦ Continue monitoring response and recovery efforts 

♦ Continue to monitor decontamination actions 

♦ Monitor evacuation status, if necessary 

♦ DHS will work to provide the installation with consequence 
management and mitigation efforts and incident oversight if 
directed by appropriate national authorities IAW the NRF (the 
NRF Nuclear/Radiological Annex and/or Terrorism Annex may be 
activated) 

♦ If directed by appropriate national authorities IAW the NRF, DHS will 
become the lead authority; FBI will maintain investigative authority 
and installation will support efforts 

♦ If DHS and/or the FBI does not assume lead IAW the NRF, the 
installation will remain the lead authority for all consequence 
management and crisis management coordination, efforts and 
actions 

♦ DoD will provide personnel, radiological resources and airborne 
sampling on request 

♦ State and local health department and HHS will ensure availability 
of medical care/other human services, crisis counseling, 
radiological incident advice, if necessary 

♦ DOE will provide radiological monitoring and assessment activities, 
generate plume models and provide reference material for 
calibrating radiological instruments; radiation shielding materials 
upon request 










INDICATIONS OF A NUCLEAR INCIDENT 


A.4 

Blast: Increased pressure and strong winds collapse buildings 
and displace objects; crushes, deforms, tumbles, shocks, creates 
projectile missiles and obstacles; flying debris and blast will cause 
physical injury 

Thermal Radiation: Intense heat burns and starts fires and will cause 
eye damage 

Nuclear Radiation: Causes immediate or delayed radiation sickness 
and may cause death within close proximity of detonation (personnel 
affected will depend on size of weapon), increases disease and non¬ 
battle injury, material and terrain contamination; neutrons and gamma 
rays produced during the first minute, but fallout may last for years 
Radiation Sickness: Severe radiation sickness resulting from external 
irradiation and its consequent organ effects is a primary medical 
concern; when appropriate medical care is not provided, the median 
lethal dose of radiation, the LD50/60 (that which will kill 50% of the 
exposed persons within a period of 60 days), is estimated to be 3.5 
grays of absorbed radiation 

Electromagnetic Pulse: Causes permanent or temporary impairment 
of electrical, electro-optical, and electronic equipment and 
communications systems 

Flashblindness: A temporary condition that occurs with peripheral 
observation of a brilliant flash of intense light energy, for example, a 
fireball; the duration of flash blindness can last several seconds when 
exposure occurs during daylight and will be followed by a darkened 
afterimage that lasts for several minutes (at night, flash blindness can 
last for up to 30 minutes) 

Psychological Effects: Include intense acute and chronic stress 
disorders 

* The above information taken from JP 3-11 and AFRRI’s Medical Management of 

Radiological Casualties Handbook. 


IN THE EVENT OF A NUCLEAR INCIDENT 
CONTACT THE NATIONAL MILITARY COMMAND CENTER (NMCC) 
(703) 692-2387 (24 HOURS / 7 DAYS A WEEK) 


39 



INCIDENT (I) TO 1+15 MIN - RESPONSE CHECKLIST 



4 Gain situational awareness 
4 Initiate concept of operations, if exists 
4 Continue the mission and critical operations 
4 Limit further damage to lives and property (contain the 
situation) 

4 Notify the NMCC via OPREP-3 incident report of terrorist/hostile 
nuclear incident (ensure nuclear detonation is reported) 

4 Confirm direct notification of Higher Headquarters, Fire, EMS, 
Security Forces, EOD, radiological response assets, if available 
4 Adjust FPCON level 
4 Activate ICP/EOC 

4 Appoint an incident commander (usually senior fire official at 
incident) 

4 Notify State and local authorities as defined in the MOUs/MOAs 
4 NMCC notifies DHS who may implement appropriate NRF 

procedures and may activate the NRF Catastrophic Incident Annex 
and/or the Nuclear/Radiological and Terrorism Annexes 
4 DHS will work to provide the installation with consequence 
management and mitigation efforts and incident oversight 
4 If directed by appropriate national authorities IAW the NRF, DHS will 
become the lead authority; FBI will maintain investigative authority 
and installation will support efforts 
4 If DHS and/or the FBI does not assume lead IAW the NRF, the 
installation will remain the lead authority for all consequence 
management and crisis management coordination, efforts and 
actions 

4 Initiate mass notification via EOC (installation emergency alert 
system) 

4 Determine protective measures 
4 Confirm first responders have made initial assessment; 
established an on-scene command post, cordon, entry/exit 
points and staging area; mitigated the situation; and 
are performing life-saving operations and initial casualty 
decontamination 


CONTINUED 


■ at 



INCIDENT (I) TO 1+15 MIN (CONT’D) - RESPONSE CHECKLIST 


♦ Confirm first responders have established hazardous/ 
contamination control zones and are utilizing personal protection 
equipment and decontamination supplies 

♦ Ensure first responders have checked for secondary devices 

♦ Identify possible further health and medical needs and available 
resources and equipment 

♦ Contact key health personnel (radiological assistance teams/ 
agencies, local hospitals, etc.) 

♦ Identify affected individuals, if necessary, implement 
contamination avoidance measures for surrounding incident area 

♦ Ensure preservation of evidence on-scene (crime scene) 


1+15 MIN TO 1+1 HR - RESPONSE CHECKLIST 



♦ Confirm establishment of National Defense Area (NDA), secure 
area around the incident site; issue airspace restrictions; maintain 
close communications with Security Forces 

♦ Order the establishment of a cordon for first responders 

♦ Ensure Security Forces are implementing protection procedures of 
personnel and installation 

♦ Assess infrastructure on-installation (communications, damage 
assessment, water/sewage/electricity, control of food, housing); 
issue notices, if necessary 

♦ Activate JIC for incident announcements on and off-installation; 
monitor notification of local/civilian public with emergency alert 
system via radio/TV, mobile public address systems, and sirens 
via JIC; JIC will also process media requests for information and 
announcements 

♦ Confirm installation mass notification and notification of local 
affected population (include directions for personal protection in 
public announcements) 

♦ Activate installation shelter-in-place or evacuation plans via EOC 
and Security Forces 

♦ Conduct follow-on reports to Higher Headquarters via SITREP 

♦ Readjust FPCON level, if necessary 

CONTINUED... 


41 




1+15 MIN TO 1+1 HR (CONT’D) - RESPONSE CHECKLIST 



♦ Work with higher headquarters to coordinate arrival of Federal/DoD 
response teams 

♦ Ensure local off-installation assets/mutual aid has access to 
installation and is arriving 

♦ Begin/obtain personnel accounting information 

♦ Monitor response and recovery actions 

♦ Confirm decontamination efforts; boundaries of hazardous/ 
contamination control zones redefined based on new information 

♦ Assist in evacuation/relocation/traffic redirection/preparation if 
necessary, via Security Forces 

♦ Confirm and maintain contact with local and State EOCs, if 
activated 

♦ Determine size/scope and ETA of DoD/Federal assets 

♦ Confirm health and security personnel have cleared and secured 
on-installation hospital entrances and grounds 

♦ Confirm all health centers (on-installation and off, if needed) 
are able to provide sufficient emergency care and that 

only life threatening injuries are receiving treatment before 
decontamination (public should be directed to seek medical 
attention only when needed) 

♦ Assess status of local public transportation, private/military 
transportation assets 

♦ Seek medical advisors for possible preventative measures or 
limiting the effects of radiation 


1+1 HR TO 1+4 HRS - RESPONSE CHECKLIST 


A.4 


♦ Continue notification of installation/local/civilian public via JIC 

♦ Confirm entry/exit control of arriving mutual aid at staging area 

♦ Coordinate with/brief arriving State, Federal and DoD agencies 

♦ Complete personnel accountability 

♦ Monitor continued response and recovery efforts and 
decontamination efforts 


CONTINUED. 


• ■ 




1+1 HR TO 1+4 HRS (CONT’D) - RESPONSE CHECKLIST 


A.4 



♦ Determine how to transport people on/off/within the installation, if 
necessary; if evacuating, Security Forces will direct this process 

♦ Installation may request the radiological assistance teams or 
agencies, (i.e. the FRMAC) 

♦ DOE and DTRA (HPAC) can model plumes; requests should go 
through their EOCs in Washington, D.C. (202-586-2830 and 
1-877-240-1187 respectively) 

♦ Appropriate office (most installations, Legal Affairs) will make 
family notifications 

♦ Continue preservation of evidence measures 

♦ Confirm non-ambulatory casualties are removed during casualty 
extraction 

♦ Continue personnel accounting of contaminated casualties at 
hospitals; coordinate with Mortuary Affairs for dead and continue 
advisory shelter-in-place/evacuation options 

♦ Ensure provision of basic needs begins, if necessary 


1+4 HRS TO 1+8 HRS - RESPONSE CHECKLIST 



♦ Monitor public announcements as new information warrants 

♦ Continue monitoring response and recovery efforts 

♦ Continue to monitor decontamination actions 

♦ Monitor evacuation status, if necessary 

♦ DoD will provide personnel, radiological resources and airborne 
sampling on request 

♦ State/local health department and HHS will ensure availability of 
medical care/other human services, crisis counseling, radiological 
incident advice, if necessary 

♦ DOE will provide radiological monitoring and assessment activities, 
generate plume models and provide reference material for 
calibrating radiological instruments; radiation shielding materials 
upon request 


43 




From AFRRI’s Medical Management of Radiobiological Casualties Handbook 


ACUTE RADIATION SYNDROME 


PHASE OF 

SYNDROME 

WHOLE-BODY IRRADIATION FROM EXTERNAL RADIATION OR INTERNAL ABSORPTION 

FEATURE 

SUBCLINICAL RANGE 

(rad or cGy) 

SUBLETHAL RANGE (RAD OR cGy) 

LETHAL RANGE (RAD OR cGy) 

0-100 

100-200 

200-600 

600-800 

600-3000 

> 3000 

INITIAL OR 
PRODROMAL 

NAUSEA, 

VOMITING 

NONE 

5-50% 

50-100% 

75-100% 

90-100% 

100% 

TIME OF 

ONSET 


3-6 H 

24 H 

1-2 H 

<1 H 

<1 H 

DURATION 

LYMPHOCYTE 

COUNT 


<24 H 

<24 H 

<1000 AT 24 H 

<48 H 

<500 AT 24 H 

<48 H 

<48 H 

CNS FUNCTION 

NO 

IMPAIR¬ 

MENT 

NO 

IMPAIRMENT 

ROUTINE TASK 
PERFORMANCE 
COGNITIVE 
IMPAIRMENT FOR 
6-20H 

SIMPLE AND 
ROUTINE TASK 
PERFORMANCE 
COGNITIVE 
IMPAIRMENT FOR 
>24H 

PROGRESSIVE 

INCAPACITATION 

LATENT 

DURATION 

>2 WKS 

7-15 D 

0-7 D 

0-2 D 

NONE 

MANIFEST 

(obvious) 

ILLNESS 

SIGNS AND 
SYMPTOMS 

NONE 

MODERATE 

LEUKOPENIA 

SEVERE LEUKOPENIA, PURPURA, 
HEMORRAGE, PNEUMONIA, HAIR 

LOSS AFTER 300 RAD (cGy) 

DIARRHEA, FEVER, 

ELECTROLYTE 

DISTURBANCE 

CONVULSIONS, 
ATAXIA, TREMOR, 
LETHARGY 

TIME OF ONSET 


>2 WKS 

2 D - 2 WKS 

2-3 D 

CRITICAL PERIOD 


NONE 

4-6 WKS 

5-14 D 

148 H 

ORGAN SYSTEM 

NONE 


HEMATOPOIETIC AND RESPIRATORY 
(MUCOSAL) SYMPTOMS 

Gl TRACT 

MUCOSAL 

SYSTEMS 

CNS 

HOSPITALIZATION 

% DURATION 

0 

<5% 

45-60 D 

90% 

60-90 D 

100% 

90+D 

100% 

2 WKS 

100% 

2 D 

FATALITY 


0% 

0% 

0-80% 

90-100% 

90-100% 

TIME OF DEATH 




3-12 WKS 

1-2 WKS 

1-2 D 









































HIGH-YIELD EXPLOSIVE (HE) INCIDENT 

INDICATIONS OF A HIGH-YIELD EXPLOSIVE INCIDENT 


Heat and Fires: Intense heat from explosion will cause burns and 
start fires 

Blast Pressure Effect (most powerful of all explosive effects): 

Expanding gases exert extreme pressure on atmosphere surrounding 
point of detonation; pressure and strong winds collapse buildings and 
displace objects in the case of a very large explosion 

Fragmentation Effect: Debris and fragmentation are produced by 
the explosive container, objects around the detonation point and the 
intended target 

Thermal Effect: High explosives produce higher temperatures for a 
shorter time; effect is seen usually as a bright flash at the moment of 
detonation; a fireball is more likely to cause a secondary fire than a 
high-yield explosive detonation 

Ground and Water Shock: Occurs when an explosive is initiated 
while buried in the earth or submerged under water - may cause 
substantially greater damage 

Blast and Flying Debris: Will cause the most physical injury and 
casualties 

Weakened and Collapsed Buildings: Will create hazardous areas 

Disorientation and Mental Trauma: For those at or close to the 
detonation site 



Ensure FIRST RESPONDERS are aware during RESPONSE and 
RECOVERY MISSIONS of SECONDARY DEVICE THREATS; If there 
is any indication of a SECONDARY CHEMICAL, BIOLOGICAL, OR 
RADIOLOGICAL (CBR) DEVICE attached to a HIGH-EXPLOSIVE 
INCIDENT, Turn to the suggested CBR INITIAL RESPONSE ACTIONS 
in this handbook. 


IN THE EVENT OF A HIGH-YIELD EXPLOSIVE INCIDENT 
CONTACT THE NATIONAL MILITARY COMMAND CENTER (NMCC) 
(703) 692-2387 (24 HOURS / 7 DAYS A WEEK) 


45 












INCIDENT (I) TO 1+15 MIN - RESPONSE CHECKLIST 


♦ Gain situational awareness 

♦ Initiate concept of operations, if exists 

♦ Continue the mission and critical operations 

♦ Limit further damage to lives and property (contain the situation) 

♦ Notify the NMCC via OPREP-3 incident report of terrorist/hostile 
high-explosive incident (if secondary devices, report as well) 

♦ Confirm direct notification of Higher Headquarters, Fire, EMS, 
Security Forces, and EOD 

♦ Adjust FPCON level 

♦ Activate ICP/EOC 

♦ Appoint an incident commander (usually senior fire official at 
incident) 

♦ Notify State and local authorities as defined in the MOUs/MOAs 

♦ NMCC notifies DHS who may declare an Incident of National 
Significance and activate the NRF Catastrophic Incident Annex 
and/or the Terrorism Annex 

♦ DHS will work to provide the installation with consequence 
management and mitigation efforts and incident oversight 

♦ If directed by appropriate national authorities IAW the NRF, DHS will 
become the lead authority; FBI will maintain investigative authority 
and installation will support efforts 

♦ If DHS and/or the FBI does not assume lead IAW the NRF, the 
installation will remain the lead authority for all consequence 
management and crisis management coordination, efforts and 
actions 

♦ Initiate mass notification via EOC (installation emergency alert 
system) 

♦ Confirm first responders have made initial assessment, established 
an on-scene command post, cordon, entry/exit points and staging 
area, mitigated the situation and are performing life-saving 
operations and initial casualty decontamination, if it exists 

♦ Ensure first responders have checked for secondary devices, if 
present, turn to CBR incident response in this manual 

♦ Identify possible further health and medical needs and available 
resources and equipment 

♦ Contact key health personnel (CBR assistance teams/agencies, 
local hospitals, etc.) 

♦ Ensure preservation of evidence on-scene (crime scene) 









1+15 MIN TO 1+1 HR - RESPONSE CHECKLIST 



♦ Confirm secure area around the incident site; issue airspace 
restrictions; maintain close communications with Security Forces 

♦ Ensure Security Forces are implementing protection procedures of 
personnel and installation 

♦ Assess infrastructure on-installation (communications, damage 
assessment, water/sewage/electricity, control of food, housing); 
issue notices, if necessary 

♦ Activate JIC for incident announcements on and off-installation; 
monitor notification of local/civilian public with emergency alert 
system via radio/TV, mobile public address systems, and sirens 
via JIC; JIC will also process media requests for information and 
announcements 

♦ Confirm installation mass notification and notification of local 
affected population (include directions for personal protection in 
public announcements) 

♦ Activate installation shelter-in-place or evacuation plans via EOC 
and Security Forces 

♦ Conduct follow-on reports to Higher Headquarters via SITREP 

♦ Readjust FPCON level, if necessary 

♦ Work with Higher Headquarters to coordinate arrival of Federal/ 
DoD response teams 

♦ Ensure local off-installation assets/mutual aid has access to 
installation and is arriving 

♦ Begin/obtain personnel accounting information 

♦ Monitor response and recovery actions 

♦ Confirm decontamination efforts, if necessary 

♦ Assist in evacuation/relocation/traffic redirection/preparation if 
necessary, via Security Forces 

♦ Confirm and maintain contact with local and State EOCs, if 
activated 

♦ Determine size/scope and ETA of DoD/Federal assets 

♦ Confirm health and security personnel have cleared and secured 
on-installation hospital entrances and grounds 

♦ Confirm all health centers (on-installation and off, if needed) are 
able to provide sufficient emergency care 

♦ Assess status of local public transportation, private/military 
transportation assets 


47 






1+1 HR TO 1+4 HRS - RESPONSE CHECKLIST 


♦ Continue notification of installation/local/civilian public via JIC 

♦ Confirm entry/exit control of arriving mutual aid at staging area 

♦ Coordinate with/brief arriving State, Federal and DoD agencies 

♦ Complete personnel accountability 

♦ Monitor continued response and recovery efforts and 
decontamination efforts, if necessary 

♦ Determine how to transport people on/off/within the installation, if 
necessary; if evacuating, Security Forces will direct this process 

♦ Appropriate office (most installations, Legal Affairs) will make 
family notifications 

♦ Continue preservation of evidence measures 

♦ Continue personnel accounting of casualties at hospitals; 
coordinate with Mortuary Affairs for dead and continue advisory 
shelter-in-place/evacuation options 

♦ Ensure provision of basic needs begins, if necessary 



1+4 HRS TO 1+8 HRS - RESPONSE CHECKLIST 


♦ Monitor public announcements as new information warrants 

♦ Continue monitoring response and recovery efforts 

♦ Continue to monitor decontamination actions, if necessary 

♦ Monitor evacuation status, if necessary 

♦ State/local health department and HHS will ensure availability 
of medical care/other human services, crisis counseling, etc., if 
necessary 















EVACUATION ACTIONS 


PRIORITIES FOR EMERGENCY EVACUATION 


Priority I: Ambulatory injured or ill personnel 
Priority II: Non-ambulatory injured or ill personnel 
Priority III: Pregnant women and families 
Priority IV: Other non-critical personnel 

Should the entire installation require evacuation, the Installation 
Commander, assisted by Security Forces, Fire, Civil Engineers/Public 
Works and Transportation will coordinate and control the movement 
of personnel off the installation to other locations through the EOC 
and the local community’s EOC. Installation evacuation/shelter- 
in-place plans will be initiated, if they exist, through MOUs/MOAs. 
Security Forces will lead the evacuation actions according 
to their own plans and knowledge of the installation. Special 
considerations need to be made concerning civilian mutual aid 
assistance entry points and procedures into the installation and into 
the local community. 


SHELTER-IN-PLACE ACTIONS 


CONTAMINATION CONTROL 
AREA (CCA) 


LIQUID 

1 

1 

VAPOR 

HAZARD 

1 

HAZARD 

AREA 

1 

AREA 

(LHA) 

1 

1 

(VHA) 


TOXIC FREE AREA 

(TFA) 


OPTIONAL 

MECHANICAL 

ROOM 


BLAST 

PROTECTED 

MAIN 

ENTRANCE 



AIR FLOW 


ocr: 


BLAST 
PROTECTED 
AIR INLET 


GENERAL LAYOUT FOR AN NBC SHELTER 


(Figure from FM 3-11.34) 


49 






































PROTECTION-IN-PLACE OPTIONS 

FOR THIS 

function: 

USE THESE ITEMS: 

with this guidance: 

Sealing Air 

Infiltration 

Points 

- Plastic Canvas 

- Plastic Sheeting 

- NBC protective covers 
(NBC-PC) 

- Foam-In-Place 

- Gasket forming materials 
(silicon, rubber gaskets, 
foam sealing materials) 

- Place plastic around inside of windows and doors. 

- Close holes and windows with plywood; seal with 
materials available (i.e. duct tape). 

- Spray foam into doorways and windows, overlapping 
all sills and openings. Foam spray will not work well 
on overhead horizontal surfaces. 

- Spray foam into all air intakes and exhausts. 

- Cut and fit plastic as necessary; use duct tape to 
hold in place. 

CAUTION: Turn off HVAC systems before sealing 
air intakes/exhausts. 

Individual 

Covers 

- Plastic Sheet 

- Plastic Canvas 

- NBC-PC 

- Military/Civilian Wet 

Weather 

- Gear/Rain Suits (Rubber) 

- Ponchos 

- Modular Chemically 

Hardened Tent (MCHT) 

- Tent extendable modular 
personnel tents (TEMPER) 

- Cut plastic sheet, plastic canvas, and NBC-PC 

1.5 times taller and wider than the individual using 
it. Use as cover to provide protection-in-place for 
personnel caught in the open. 

- Make rain suits/ponchos part of daily work uniform, 
use in conjunction with plastic sheet, plastic canvas, 
and NBC-PC. 

- Pre-position MCHT and TEMPER throughout fixed 
sites, concentrate on areas with few approved 
shelters, but high personnel concentrations, 

Materiel 

Covers 

- Plastic Sheeting 

- Plastic Coated Canvas 

- NBC-PC 

- Large Area Shade Systems 

- Large Area Maintenance 
Shelter 

- Cut and fit as necessary, use duct tape to hold in 
place. 

- Place covered material under shade systems or 
shelters for additional protection. 

Shelters 

- Container Express (CONEX) 

- Military-Owned 

Demountable 

- Container (MILVAN) 

- Modular command post 
system (MCPS) 

- Modular General Purpose 
Tent System (MGPTS) 

- Place CONEX/MILVAN at regular intervals around 
fixed sites. Attach plastic sheet/NBC-PC to front 
of CONEX/MILVAN of sufficient size to cover the 
opening and to act as a liquid barrier. Attach weight 
(piece of wood/iron bar, etc) to bottom edge of 
plastic to hold in place when being used. 

- Erect MCPS/MGPTS at specified intervals (based 
on personnel concentrations). 

- Use these measures in conjunction with individual 
and materiel covers. 

Vertical 

Separation 

- Plastic Sheeting 

- Plastic Coated Canvas 

- NBC-PC 

- Move operations to upper floor/levels. 

- Block entryways and openings with multiple sheets 
of plastic. Place a plastic sheet at foot of stairs, 
another partway up the stairs, a third at the top of 
the stairs, etc. 

CAUTION: The duration of protection using these measures is not quantified and is provided for 
emergency situations only. This table does not preclude using other expedient measures afforded by 
available materials and common sense. 

» . . .... -- .. - - - ----- 


From FM 3-11.34, Table J-2 


50 







































SITUATION REPORT (SITREP) 


DO NOT DELAY SENDING THE REPORT WHILE WAITING 
FOR COMPLETE OR ADDITIONAL INFORMATION! 

— 

EXAMPLE SITUATION REPORT [SITREP] 

1. Name, physical address and mailing address of facility 

2. Name and telephone number of qualified individual 
to be contacted for further information 

3. Name and telephone number of person making report 

4. Date/time and location of incident 

5. Identification of type of event being reported (CBRNE) 

6. Area affected and wind conditions 

7. Casualties 

8. Property damage/status of critical facilities 

9. Response actions (ongoing, anticipated and recommended/ 
requested) 

10. Agencies notified 


51 





OPREP-3 PINNACLE REPORT 


FROM FM 3-11.21: 


According to Chairman of the Joint Chiefs of Staff Manual 3150.03, 
the installation will submit an operations report (0PREP)-3 in the event 
of a terrorist WMD incident directly to the NMCC. The goal is to make 
initial voice reports within 15 minutes of an incident, with message 
reports submitted within 1 hour of the incident. The initial report 
must not be delayed to gain additional information. Follow-up reports 
can be submitted as additional information becomes available. 

The installation will submit voice reports sequentially to the NMCC, 
appropriate Commanders, and the reporting unit’s parent service 
and intermediate superior command. Conference calls or concurrent 
telephone calls should be considered if no delays are encountered 
and security can be maintained. There will remain an open line 
between the NMCC and the installation throughout the duration of 
the incident. All OPREP-3 will be submitted as soon as possible after 
an event or incident has occurred and sent at FLASH or IMMEDIATE 
precedence. Message Address: JOINT STAFF WASHINGTON DC//J3 
NMCC//. 




REFERENCES 


National Response Framework. Department of Homeland Security. 
January 2008. 

National Incident Management System. Department of Homeland 
Security. December 2008. 

Joint Publication 3-11, Joint Doctrine for Operations in Nuclear, 
Biological, and Chemical (NBC) Environments. August 2008. 

Joint Publication 3-40, Joint Doctrine for Combating Weapons of Mass 
Destruction. 10 June 2009. 

CJCSM 3150.03, Joint Reporting Structure and Event and Incident 
Reports. 19 June 1998. 

DoDI, Number 2000.18, DoD Installation CBRNE Emergency 
Response Guidelines. ASD(SOLIC). 4 December 2002. 

FM 3-11.21, MCRP 3-37.2C, NTTP 3-11.24, AFTTP(I) 3-2.37, 
Multiservice Tactics, Techniques, and Procedures for Nuclear ; 
Biological, and Chemical Aspects of Consequence Management. 

12 December 2001. 

FM 3-11.34, MCWP 3.37.5, NTTP 3-11.23, AFTTP(I) 3-2.33, 

Multiservice Procedures for Nuclear, Biological, and Chemical (NBC) 
Defense of Theater Fixed Sites, Ports and Airfield. 

29 September 2000. 

Medical Management of Radiological Casualties Flandbook. Military 
Medical Operations, Armed Forces Radiobiology Research Institute. 
Bethesda, Maryland. April 2003. 

Defining Personal Protective Equipment. Office of Occupational Safety 
and Health, Department of Labor. Regulations (Standards-29 CFR) 
Part 1910.120 AppB. 22 August 1994. 

Chemical/Biological/Radiological Incident Flandbook. Interagency 
Intelligence Committee on Terrorism (HOT). October 1998. 

DoD Concept of Operations for CBRNE Defense Supporting US Military 
Installation and Facility Preparedness. October 2003. (Draft) 

CNI 3440.17, Navy Installation Emergency Management Program. 

22 July 2005. 

Advanced Disaster Medical Response: Manual for Providers. Ed. 

Susan M. Briggs. Harvard Medical International. Boston, 2003. 


53 






NOTES 



















































Domestic & Foreign 
Consequence 
Management 
Planning 


CBRN & 
Consequence 
Management 
Training Exercises 


Consequence 
Management 
Advisory Teams 
(CMAT) 

Deployable Assistance 


Analysis of 
Real World & 
Exercise Observations 



We specialize in 
planning, executing, 
and guiding 
Chemical, Biological, 
Radiological & 
Nuclear (CBRN) 
Consequence 
Management 
training & exercises 


We provide on-scene 
technical advice 
and capabilities 
including 
hazard prediction 
modeling 

for Joint Task Force, 
Response Task Force 
and Global 
Combatant 
Commanders 


Contact us at CM@DTRA.MIL 


















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